不安定腰椎に対する Pedicle Screw 法と Wire 固定術の比較検討

抄録

We prospectively investigated and compared the results from wire fixation and those from pedicle screw fixation for an unstable lumbar spine. Between April 1992 and July 1996, we surgically managed 44 cases of unstable lumbar spine using either wire fixation or pedicle screw fixation. Wire fixation was employed for 22 patients (11 male and 11 female, with a mean age at surgery of 51.1 years), and pedicle screw fixation was employed for 22 patients (8 male and 14 female, with a mean age at surgery of 57.1 years). The results showed no difference in % slip, slip-angle, frequency of bone union, or in frequency of instrument failure between those that had received wire fixation and those that had received pedicle screw fixation. In those with lumbar spondylolisthesis, the operative results were excellent or good in only 7 (53.8%) of 12 cases treated with wire fixation and in 13 (81.6%) of the 16 treated with pedicle screw fixation. In those with lumbar disc herniation or lumbar canal stenosis, there was no significant difference in the results between those that had been treated with wire fixation and those that had been treated with pedicle screw fixation.
We concluded from these short term results that wire fixation was sufficient for an unstable spine with lumbar disc herniation or lumbar canal stenosis, while pedicle screw fixation was better than wire fixation for an unstable spine with lumbar spondylolisthesis.